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Obstruction of the right coronary artery ostium due to acute aortic dissection

Salvatore Patanè, Filippo Marte, Salvatore Lentini

    International Journal of Cardiology
    |January 8, 2008
    PubMed

    Insights

    Acute aortic dissection can mimic acute coronary syndrome, delaying diagnosis. Vigilance for atypical chest pain in hypertensive patients is crucial for accurate diagnosis and timely treatment.

    Area of Science:

    • Cardiology
    • Vascular Surgery
    • Emergency Medicine

    Background:

    • Acute aortic dissection (AAD) is a life-threatening condition often presenting with diverse symptoms.
    • AAD is frequently misdiagnosed as acute coronary syndrome (ACS), leading to treatment delays and adverse outcomes.
    • A high index of clinical suspicion is essential for prompt diagnosis.

    Observation:

    • A 68-year-old woman with a history of arterial hypertension presented with new-onset atypical chest pain.
    • Electrocardiographic findings mimicked acute coronary syndrome.
    • Despite normal D-dimer levels, an ascending aortic aneurysm was discovered, leading to the diagnosis of acute aortic dissection.

    Findings:

    • The case highlights the diagnostic challenge of AAD mimicking ACS.
    • Normal D-dimer levels do not exclude AAD, particularly in the context of atypical chest pain.
    • Longstanding arterial hypertension is a significant risk factor for AAD.

    Implications:

    • Emphasizes the need for a thorough differential diagnosis in patients with new-onset chest pain.
    • Highlights the importance of considering AAD even with non-specific symptoms and normal D-dimer levels.
    • Underscores the critical role of clinical suspicion in managing potentially fatal cardiovascular emergencies.

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